A 6 month-old male presents to the emergency room with progressively increasing work of breathing. A chest x-ray obtained shows the following:


Chest Xray to review

Case courtesy of Dr Jeremy Jones, From the case rID: 24086

What are you concerned about?




This X-ray demonstrates cardiomegaly with prominent lung markings, which is suggestive of heart failure as the etiology of this infant’s respiratory distress.


Heart Failure in Children: The Basics

  • In the US, the most common cause of pediatric heart failure is structural congenital heart disease. In children with structurally normal hearts, cardiomyopathy is the most common cause of heart failure. [Hsu et al, 2009]
  • Heart failure presents when the metabolic demands of the body exceed cardiac output.
  • Clinical Presentation is Diverse & Age related. [Madriago et al, 2010]
    • Neonates: Feeding Difficulties and ultimately Failure to Thrive
    • Older Children: Fatigue, GI symptoms, and exercise intolerance
  • Physical Exam:
    • “Pulmonary”: Tachypnea, Respiratory Distress (retractions, grunting), crackles on auscultation
    • “Cardiac”: Tachycardia, gallop rhythm
    • “GI”:  hepatomegaly

Faculty Reviewer: Kristin Lombardi, MD
Radiology Reviewer: Laura Sternick, MD


Hsu DT et al. “Heart Failure in Children, Part I: History, etiology, and pathophysiology.” Circ Heart Fail. 2009;2:63-70

Madriago E et al. “Heart Failure in Infants and Children.” Pediatrics in Review. 2010;31(1)4-12.